Stay at Home Toolkitfor Seasonal and Pandemic Influenza

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Stay at Home Toolkit

Table of Contents

Section 1: Prevention• Preventing the Spread of Influenza 2• Cover Your Cough 5• Maintain a Healthy Mind and Body 6• How to Use a Thermometer 8• Formula for Disinfection 9• Influenza Stay at Home Toolkit Contents 10

Section 2: Caregiving - Care for Family, Friends, Neighbors, and Pets• How to Care for Someone with Influenza 11• Personal Care Log 14• Taking Care of a Pet during an Emergency 15• Returning to Work after Influenza Illness 17

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Preventing the Spread of Influenza

Most people with influenza will be able to remain at home while they are sick. They can care for themselves or be cared for by others who live in the household. This information is intended to help people recognize the symptoms of influenza and care for ill people in the home, both during a typical influenza season and during an influenza pandemic.

Know the symptoms of influenza, which may include:Sudden onset of illness, chills, headache, stuffy nose, feeling of weakness, fever higher than 100.4 degrees Fahrenheit, cough, sore throat, and muscle aches. In children, symptoms may include diarrhea, vomiting, stomach pain and/or feeling really tired.

Prevent the spread of illness in the homeInfluenza viruses are spread from person to person primarily through sneezing and coughing. The virus may also be spread through con-tact with germs on the hands of a sick person or by touching ob-jects or surfaces that have been touched by a sick person. For this reason, it is important to take steps to prevent the spread of influ-enza to others.

Seasonal influenza vaccineIt’s a good idea to get a seasonal influenza vaccine (a shot or nasal mist) to give some protection to an influenza outbreak in the community. For more information on seasonal flu vaccine, please call 1-800-232-4636 or go to the Michigan Department of Community Health (MDCH) Seasonal Influenza Page (www.michigan.gov/flu).

What caregivers can doCaregivers need to physically separate those who are ill with influenza from other people as much as possible. When practical, the ill person should stay in a separate room away from other people. Other people living in the home should limit contact with the ill person as much as possible. One person in the household should be the main caregiver for the ill person. Ideally, this caregiver should be healthy, be capable to take personal precautions, and not have medical conditions that would put him or her at risk of severe influenza disease.

Medical conditions considered “high risk” include the following:Pregnancy, heart problems, disease or treatment that suppresses the immune system, chronic lung diseases, diabetes, kidney disease, over the age of 65.

Prevention

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Preventing the Spread of Influenza

What everyone in the household can do:

Wash hands with soap and water. If soap and water is not available, use an alcohol-based cleaner/hand • sanitizer (like Purell® or a store-brand) after each contact with a person with influenza or with objects in the area where the person is located. WASHING YOUR HANDS IS THE SINGLE BEST PREVENTIVE MEASURE FOR EVERYONE IN THE HOUSEHOLD.

Do not touch your eyes, nose, or mouth without first washing your hands for 20 seconds (sing Happy • Birthday twice). Wash hands before and after using the bathroom.

Wash dirty dishes either in a dishwasher or by hand with warm water and soap. It’s not necessary to • separate eating utensils used by a person with influenza.

It’s not necessary to separate soiled linen and laundry used by a person with influenza from other • household laundry. Laundry can be washed in a standard washing machine with warm or cold water and detergent. Do not hold or carry the laundry close to your body or face, in order to avoid contamination. Wash hands with soap and water after handling soiled laundry.

Place tissues used by the ill person in a bag and throw it away with other household trash. Consider • placing a bag at the bedside of the ill person for this purpose. There is no requirement for special handling of this trash.

Clean counters, surfaces and other areas in the home regularly using normal cleaning products. •

Other household members with influenza:If possible, contact your health care provider if you have questions about caring for the ill person. If there is widespread influenza illness in your community or region, it may be difficult to contact your usual healthcare provider. The Michigan Department of Community Health will provide frequent updates, including where to get medical advice. If special telephone hotlines are used, these numbers will be announced through the media.

Wearing surgical masks (with ties) or procedure masks (with ear loops) may be useful in decreasing spread of influenza when worn by the ill person and/or caregiver during close contact (within 6 feet). If masks are recommended by the Michigan Department of Community Health (MDCH) or the Centers for Disease Control and Prevention (CDC), they must be worn at all times when in close contact with the ill person to be effective. Wearing gloves and gowns are not recommended for household members providing care in the home.

Prevention

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Prevent the Spread of Illness in the Community

Stay at home if you are sick. Ill persons should not leave the home until they have recovered, because they can spread the infection to others. In a typical influenza season, persons with influenza should avoid contact with others for about 5 days after exposure to the illness.

You and your loved ones may want to use the Internet as a primary resource. The Internet can serve as a link to outside resources such as: up-to-date information on influenza, medical and social services, and access to food delivery services. The Internet will help reduce the spread of influenza by allowing ill persons to stay at home. If the ill person must leave home (such as for medical care), he or she should wear a surgical or procedure mask, if recommended, and do the following:

Seasonal Influenza

Cover mouth and nose when coughing and sneezing, using tissues or the crook of the elbow instead • of the hands.

Use tissues to contain mucous and watery discharge from the mouth and nose.•

Dispose of tissues in the nearest waste bin after use or carry a small plastic bag (like a Ziploc® bag) for • used tissues.

Wash hands with soap and water or use an alcohol-based hand cleaner after covering your mouth for • a cough or sneeze, after wiping or blowing your nose, and after handling contaminated objects and materials including tissues.

Pandemic Influenza

During an influenza pandemic, travel should be minimized. Only people who are essential for care or support should enter a home where someone is ill with pandemic influenza.

If other persons must enter the home, they should avoid close contact with the ill person and use the • infection control precautions recommended in this document.

During an influenza pandemic, public health authorities will provide information on how long people • with influenza should remain at home.

Prevention

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Prevention

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Maintain a Healthy Mind and Body

Things to remember when trying to understand an influenza outbreak or pandemic:

It is normal to worry about yourself and your family’s safety.•

Everyone may be affected by an influenza pandemic.•

Grief and anger are normal reactions.•

Focusing on your strengths will help you heal.•

Everyone has different needs and different ways of coping.•

Common reactions that may occur during an influenza outbreak or pandemic could be:

Difficulty talking, sleeping, walking, and concentrating.•

Increased irritability.•

Depression, sadness, mood swings, and crying easily.•

Feelings of helplessness.•

Worrying about loss of income and job protection, especially • if asked to stay at home for an extended period of time.

Concerns about those who depend on you for care.•

Fear of separation from life activities.•

Feeling a lack of control, especially when control is in the • hands of others.

Increased boredom.•

How to keep healthy when staying at home:

Learn as much as you can about flu, and be aware of normal reactions during a flu outbreak or • pandemic.

Keep to your usual routine, as much as possible, recognizing that routine work may be interrupted.•

Prevention

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Maintain a Healthy Mind and Body

Get plenty of sleep, try to exercise, eat healthy, • and relax.

Have activities on-hand that can prevent • boredom (games, toys, etc.) and keep your mind active.

Contact a mental health professional or call • your local Community Mental Health Services Program* before, during, and after an influenza outbreak or pandemic, if self-help strategies are not working or if you find that you are using spare drugs/alcohol in order to cope.

Keep your living space as comfortable as • possible.

Pay Special Attention to Children

Let children know it is okay to feel upset when something scary happens. •

Encourage children to express feelings and thoughts, without making judgment. •

Enjoy your child and take part in activities together. •

Turn off the TV and radio, especially if the news makes you or your child worry. •

*Resources:

Michigan Community Mental Health Services Programs are delivered through county-based community • mental health services programs. Click here to obtain a list of phone numbers for services in your county. http://www.michigan.gov/mdch/0,1607,7-132-2941_4868_4899-178824--,00.html

Free or Low-Cost Mental Health Care http://www.michigan.gov/mdch/0,1607,7-132-2943_52115-• 203750--,00.html

SAMHSA National Center for Trauma-Informed Care - http://mentalhealth.samhsa.gov/nctic/ •

FEMA Disaster Assistance - http://www.fema.gov/ •

International Critical Incident Stress Foundation - http://www.icisf.org/ •

Green Cross Academy of Traumatology - http://www.greencross.org/•

Prevention

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How to Use a Thermometer

Use a digital thermometer with numbers, not the old kind of thermometer with mercury (a silver or red line). Old thermometers that contain mercury are a danger to the environment and to human health, and they should be disposed of properly. Please contact the Michigan Department of Environmental Quality (DEQ) Environmental Assistance Hotline at 1-800-622-9278 for directions on how to dispose of your old thermometers.

Oral Use (basic digital thermometer only):

Place the end of the thermometer well under the tongue. • The mouth should remain closed.

Do not bite the thermometer.•

When you hear “beep” sounds, remove the thermometer • from the mouth.

Read the numbers on the screen. Average human tempera-• ture is 98.6 degrees Fahrenheit (37 degrees Celsius).

Underarm Use

Place the end of the thermometer in the armpit so that the probe touches the skin. Hold the arm next • to the body.

• When you hear “beep” sounds take out thermometer. Read the numbers on the screen. Average hu-man temperature is 98.6 degrees Fahrenheit (37 degrees Celsius).

Rectal Use

Rectal thermometers are recommended for babies and young children. Instructions for this method • are in the thermometer package. There are times when you may have to take an adult’s temperature rectally.

How to clean the thermometer

Use alcohol wipes or a cotton ball saturated with 70% isopropyl alcohol (also known as rubbing alco-• hol.)

Rub the alcohol wipe over the entire thermometer.•

Dry the thermometer with a clean dry cloth or cotton ball.•

NEVER return an unclean thermometer to the storage case.•

Note: If taking many temperatures, use a plastic cover for the end of the thermometer. DO NOT reuse thermometer covers.

Prevention

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Formula for Disinfection

It is important to clean surfaces such as counters, toilets, sinks, railings, telephones, computer keyboards, mouse, remote controls, and other common surface areas in your house.

Disinfectant RecommendedUse

Precautions

Household bleach may be used in a 1 to 10 ratio with water. For example, to make approximately 1 quart of disinfectant: mix 1/3 cup bleach with 3 and 1/3 cups water.

To protect the disinfectant properties of bleach, store it in a container you can’t see through, avoid exposure to sunlight. Remix daily for maximum effectiveness.

Clorox® surface spray is a good pre-mixed alternative. Surface disinfecting wipes are also a suitable substitute.

Disinfection of material contaminated with blood and body fluids.

Should be used in well-ventilatedareas.

Gloves and protective clothingrequired while handling and us-ing undiluted bleach.

DO NOT mix with strong acids or ammonium-based products to avoid release of dangerous fumes.

Corrosive to metals.

Alcohol:e.g. 70% isopropyl alcohol (also known as rubbing alcohol)

Smooth metal surfaces, tabletops, and other surfaces on which bleachcannot be used.

Flammable and toxic. To be used in well-ventilated areas. Avoid inhalation.

Keep away from heat sources, electrical equipment, flames and hot surfaces.

Lysol® disinfectant spray Disinfection of most household surfaces and some fabrics that have been contaminated with bacteria, viruses, and mold.

Flammable and toxic. To be used in well-ventilated areas. Avoid inhalation.

Keep away from heat sources, electrical equipment, flames and hot surfaces.

(Source: The Johns Hopkins University & Johns Hopkins Health System, 2005)

Prevention

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Influenza Stay at Home Toolkits

List of recommended items for people to include in their emergency kits at home:

Thermometer (digital preferred)—information on taking your temperature and • cleaning a thermometer is included in this kit.

Alcohol wipes or cotton balls that are saturated with 70% isopropyl alcohol (also • known as rubbing alcohol) to clean the thermometer.

Fever-reducing medication such as ibuprofen (Motrin® or Advil™) or • acetaminophen (Tylenol™)—take as directed by a physician.

Juices & liquids—hydration is important.•

Bleach—formula for disinfection is included in this kit.•

Plastic/Paper utensils, plates, cups, and napkins—to avoid the need to wash dishes • used by person(s) with influenza.

Tissues—in order to contain respiratory secretions. Dispose of used tissues in • nearest waste receptacle after use.

Soap and water—for handwashing if water is available.•

Hand Sanitizer (like Purell®)—to be used if water is not available.•

Trash bags—to dispose of waste products (e.g., tissues, plastic and paper prod-• ucts).

Surgical mask (with ties) or procedure mask (with ear loops), one for each person in • the household. Use only if instructed to do so by public health officials.

List of Internet resources for possible delivery of goods and services to your home • (e.g., groceries, medical products).

Prevention

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How to Care for Someone with Influenza

During a severe influenza outbreak or pandemic, when people are infected all over the world, the media and healthcare providers will tell residents of Michigan how to obtain medical advice and care. The following information is a general guide and is not intended to take the place of medical advice from a healthcare provider.

Monitoring and ComfortingKeep a care log for each ill person in the household. Record the date, time, and what you observed. Record the following information about the ill person at least once each day or more often as symptoms change. Please see the enclosed care log. (See Page 14.)

Check the person’s temperature using a digital thermometer.• Check the person’s skin for color (pink, pale or bluish) and rash.• Record the approximate quantity of liquids consumed each day and through the night.• Record how many times the ill person urinates each day and the color of the urine (clear to light yellow, • dark yellow, brown, or red).Record all medications, dosages, and times given.•

Keep tissues, and a trash bag for their disposal, within reach of the ill person.

Remember that fever is a sign that the body is fighting the infection. It will go away as the person gets better. Sponging the ill person with lukewarm (wrist-temperature) water may lower their temperature, but only during that time. Do not sponge with alcohol.

Watch for Complications of InfluenzaComplications are common in individuals with health conditions such as diabetes, heart disease, and lung problems, but may occur with anyone who has influenza. If the ill person develops any of the following symptoms, call your healthcare provider.

Difficulty breathing, fast breathing, or bluish color to the skin or lips.• Coughing up blood.• Signs of dehydration. (See Page 12.)• Difficulty responding or communicating appropriately or appears confused.• Convulsions (seizures).• Gets worse after appearing to improve (change in condition).• Is an infant younger than 2 months old with a fever, poor feeding, urinating less than 3 times per day or • other signs of illness?

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How to Care for Someone with InfluenzaMedications:

Adults:Use ibuprofen (Advil™ or Motrin®) or acetaminophen (Tylenol™) or other measures, as recommended by your healthcare provider, for fever, sore throat and general discomfort.

Children:Do not use aspirin in children or teenagers because it can cause Reye’s syndrome, a life-threatening ill-ness.

Liquids and Nutrition:

Recommended minimum daily liquid intake, if not eating solid food:Young children need 1 ½ oz. of liquid per pound of body weight per day. To determine how much liquid your child needs, multiply the weight of your child times 1.5.

A 10 lb. child needs approximately 15 oz. fluid per day.• A 20 lb. child needs approximately 30 oz. fluid per day.•

Older children and adults need1 ½ to 2 ½ quarts per day (3-5 8 oz. cups or 2-3 12 oz. cans or bottles).

No Vomiting Present:Vomiting is not a symptom of influenza, but may be associated with other viral infections. If the person is not vomiting, offer small amounts of liquids frequently to prevent dehydration, even if he or she does not feel thirsty. If the ill person is not eating solid foods, include liquids that contain sugars and salts. Regular urination is a good sign of hydration.

Liquids that Contain Sugars and Salts:Broth or soups, sports drinks like Gatorade® (diluted half- and-half with water), Pedialyte® or Lytren® (undiluted), ginger ale, cola, and other sodas can be used. Avoid diet drinks or drinks with high amounts of caffeine.

Vomiting Present:If the person is vomiting, do not give any liquid or food by mouth for at least 1 hour after vomiting stops. Let the stomach rest. Next, offer a clear liquid such as water, weak tea, ginger ale, or broth in very small amounts. Start with 1 teaspoon to 1 tablespoon of clear liquid every 10 minutes. If the person vomits, let the stomach rest again for an hour. Again, try to give small frequent amounts of clear liquid. When there is no vomiting, gradually increase the amount of liquid offered and use liquids that contain sugars and salts. After 6-8 hours of a liquid diet without vomiting, add solid food that is easy to digest such as saltine crackers, dry toast, soup, mashed potatoes or rice. Gradually, return to a regular diet. Breast-fed babies who vomit between feedings can continue to nurse. Let your baby nurse more often by breastfeeding for 4-5 minutes every 30-45 minutes or by offering small amounts (1/2 ounce or less at a time) of Pedialyte® or Lytren® every 10 minutes in a bottle.

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How to Care for Someone with Influenza

An ill person and his/her caregivers should avoid drinking alcohol and using tobacco. Do not allow smoking in the house, as this may impact others who are ill.

Signs of Dehydration or Not Drinking Enough Liquids:Decreased output of urine, which becomes dark yellow in color from dehydration. Ill people who are • getting enough liquids should urinate at least every 8-12 hours.Weakness or unresponsiveness.• Decreased saliva/dry mouth and tongue.• Sunken eyes.• Skin tenting or turgor: check this by picking up layers of skin between your thumb and forefinger and • gently pinching for 1 second. Normally, the skin will flatten out into its usual shape right away. If the person is dehydrated, the skin will “tent” or take 2 more seconds to flatten out. This is best checked on the belly skin of a child and on the upper chest of an adult.For infants, dehydration symptoms would be fewer than 3 wet diapers in a 24-hours period.• If the ill person is dehydrated, give sips or spoonfuls of liquids frequently • over a 4-hour period. Watch for an increase in urination, a lighter color of urine, and improvement in the person’s overall condition.

Dehydration in infants and the elderly can be dangerous. Seek medical attention immediately if symptoms continue to worsen.

Sources: This document was adapted and reprinted with permission of Public Health – Seattle & King County, WA. Information obtained from the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration.

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Personal Care LogA table for tracking a person’s health during the flu.

(Copy, fill out, and bring log sheets to health care provider visits.)

Name______________________________ Name of health care provider__________________________

Date Time Observations Temperature Medications Liquids Frequency of Urination

*Any symptoms such as coughing, confusion, how the person looks, what the person is doing, liquids or foods taken since last observation.

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Caregiving

Taking Care of a Pet during an Emergency

Identify pet supply storage locations at home

Keep supplies out of direct sunlight. • Keep supplies out of an area where wild animals may have access to them. •

Microchip your pets

Microchips are an effective way of reuniting lost pets and their owners.• Make sure your microchip registration is up-to-date.• Make sure your pets have an ID tag also. •

Start a buddy system

Work with your neighbors to plan on caring for each others’ animal(s) during a pandemic.• Make sure they have your emergency contact information.• Make sure they are comfortable with your animal(s).•

Store pet supplies

Make sure there are enough supplies for • each pet for at least two weeks, but ideally up to twelve weeks.

Take photos with your pet

A photo of you with your pet can prove • ownership if you are separated.Keep copies of the photos in your wallet • and/or cell phone.Give copies of the photos to loved ones. •

Reference: UAN Animal Disaster Planning Handbook: www.uan.org

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Caregiving

Food

Store food supply in air-tight, waterproof containers.• If using canned food, include a can opener and spoon.• Rotate food every two months to prevent spoilage. •

Water

Store water supply in air-tight, waterproof containers. • Avoid storing water in direct sunlight.• Rotate water every two months to prevent spoilage.•

First Aid/Medication

Basic animal first aid and instruction book. • Supply of a pet’s prescription medication.• Heartworm and flea/tick prevention. •

Identification

Photos of your pets to show their unique markings. • Photos of you with your pets.• ID tags. •

Animal Care

Collar and leash/harness. • Food and water bowls.• Blankets, toys, and treats. •

Cleaning Supplies

Paper towels. • Soap.• Plastic bags.• Cat litter and tray. •

Reference: UAN Animal Disaster Planning Handbook: www.uan.org

Stay at Home Pet Supply Checklist

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Suggestions for Someone Who Has Recently Recovered from Influenza and Is Able to Return to Work

Overview of Influenza (Flu) Flu viruses are spread from person to person primarily through coughing and sneezing. For example, when a sick person coughs or sneezes near someone else, the virus can be transmitted. The virus may also be spread through contact with germs on the hands of a sick person or by touching objects or surfaces that have been touched by a sick person. For this reason, it is important to take steps to prevent the spread of influenza to others.

The typical incubation period (the time between when a person is first exposed to when signs and symptoms develop) for flu is 1-4 days, with an average of 2 days. Adults can make other people sick from the day before symptoms begin through approximately 5-7 days after illness begins. Children can make other people sick for more than 10 days after the onset of symptoms. Someone who has problems naturally fighting off illness (immunocompromised) can be infectious for weeks or months.

Current Criteria for Employees Returning to Work after Seasonal InfluenzaWorkers who have become ill with the flu are recommended to stay at home until all of the following criteria are met:

At least 5 days have passed since the symptoms of illness began; AND• Fever has resolved and has not been present for at least 24 hours; AND• Cough is improving (decreasing in frequency and amount of secretions with • no associated chest discomfort or shortness of breath).

Upon returning to the work environment, employees should continue to follow cough etiquette and hand washing protocols. (See Cover Your Cough, Page 5).

Criteria for Pandemic InfluenzaExperts do not know whether the mode of transmission, incubation period, or contagious period of a pandemic influenza virus will be similar to those of the regular seasonal influenza. Because of this, employers must be alert to specific recommendations from the Michigan Department of Community Health during an influenza pandemic. Management of illness in the workplace, including when it is safe for workers to return to work, will be communicated through various media as necessary. For the most current information visit the Michigan Department of Community Health’s influenza website at www.michigan.gov/flu.

Source: This document was adapted and reprinted with permission of Public Health – Seattle & King County, WA.

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State of Michiganwww.michigan.gov Michigan Department of Community Health Flu Pagewww.michigan.gov/flu

Centers for Disease Control and Preventionwww.cdc.gov

Centers for Disease Control and Prevention Info1-800-232-4636 The Department of Health and Human Services Pandemic Influenza Page www.flu.gov World Health Organizationwww.who.int American Red Crosswww.redcross.org

Substance Abuse and Mental Health Services Administrationwww.samhsa.gov The Humane Society of the United Stateswww.hsus.org

Production Date: March 2009.

This publication is supported by Cooperative Agreement Number 5U90/TP517018-09 from the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibiity of the authors and do not necessarily represent the official views of CDC. MDCH is an equal opportunity employer, service and program provider. 3000 printed at $1.97 each with a total cost of $5923.70.

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